The institutional, socio-economic and proximal factors of women's suicide mortality

Abstract

Women’s suicide is a serious public health problem. However, relatively less attention has been given to this topic. It may be linked to the conventional wisdom that suicide is predominately a male problem. This thesis focuses on suicide mortality in women with an emphasis on the impacts of social contextual factors. This contrasts with much of the previous literature on women’s suicide that has tended to emphasise individual psychopathological determinants. Specifically, this thesis investigates how different contextual factors, including institutional, socio-economic, and proximal factors (i.e., the use of suicide methods) are associated with the variations in women’s suicide mortality. The first study conducted on this topic found that institutional discrimination against women, as manifested in formal and informal laws, is relevant to the country's income-level variability in women's suicide propensity. In low- and middle-income countries, where, by law, women had unequal rights in family, restricted access to financial assets and restricted civil liberties, male-to-female suicide rate ratios were lower—that is, women's suicide rates were relatively higher. The second study illustrated the power of social and economic change in influencing women’s suicide mortality in China. From 1990 to 2015, urbanisation was the main driver of the decline in women’s suicide mortality. It also demonstrated that while initial economic prosperity and urbanisation substantially lowered women’s suicide mortality, continued development had diminishing impacts. This implies for China, and possibly other low-and middle-income countries that the sustainable reduction of women’s suicide rates cannot simply rely on improving their materialistic and economic conditions. Holistic mental health campaigns and other social level interventions are needed to sustain the improvement of women’s well-being. The third study used the meta-analysis to estimate the lethality of suicide methods in women’s suicide acts. It is found that overall, the most lethal suicide method for women was firearms. 76% of suicide acts using this method proved fatal. Suicide methods with low lethality were drug/liquid poisoning and cutting. Less than 5% of women’s suicide acts involving these methods resulted in deaths. For most method categories, the probabilities of dying among women’s and men’s suicide acts were similar if they used the same method. The fourth study reported the gender-specific suicide act rates and case-fatality rates overall and by suicide methods in Hong Kong. It revealed that the relatively high suicide rates among women and the corresponding low M/F suicide rate ratios documented in Hong Kong might not have resulted from the high rates of suicide behaviours among Hong Kong women. The high case-fatality rate, which was mainly driven by the large proportion of women’s suicide acts involving jumping — an easily accessible and lethal suicide method in HK— was likely to be the most important determinant. This thesis reveals that women’s suicide cannot be simply regarded as a phenomenon caused by mental illness or psychological fragility. Social contextual factors do play a key role in influencing the epidemiological pattern of women’s suicide mortality. Prevention strategies for women’s suicide should incorporate social-context perspectives to formulate effective measures as a way to reduce the tragedies.